Category Archives: healthy habits

Croakey: Impact of big food health washing

 

http://blogs.crikey.com.au/croakey/2014/12/01/as-nutritionists-enable-health-washing-by-coca-cola-a-call-to-end-unhealthy-sponsorship/

As nutritionists enable health-washing by Coca-Cola, a call to end unhealthy sponsorship

When Big Food companies engage in health-washing tactics, what are the consequences for the reputations of the health organisations and health professionals involved?

It’s a question the Nutrition Society of Australia and its members might be pondering, after having Coca-Cola as a gold sponsor of their recent annual scientific meeting.

As the World Cancer Congress in Melbourne this week puts the spotlight on the implications of rising obesity rates for cancer, health advocate Todd Harper highlights the contribution of soft drinks to obesity, and argues that health organisations need to look for healthier funding sources.

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Todd Harper, CEO of Cancer Council Victoria, writes:

No sporting club or health event would accept sponsorship from a tobacco company in Australia today, even if it was allowed.

We know that smoking kills, and so do everything possible to reduce its visibility to ensure younger people aren’t encouraged to take up the habit.

Obesity is also a known risk factor for many cancers, as well as other chronic diseases, yet organisations and events continue to accept sponsorship from the very companies peddling products that contribute to this significant health issue.

Despite this, some organisations focused on health, and particularly healthy kids, see little problem in holding their hands out for money from soft drink companies.

Our recent Cancer in Victoria: Statistics and Trends 2013 report revealed uterine cancer rates are steadily rising; a cancer for which obesity is a principal risk factor. Obesity is also a risk factor for breast, bowel, oesophageal, pancreas, uterine, kidney, gallbladder and thyroid cancers.

In fact, we recently learned from the World Health Organization (WHO) that nearly half a million new cancer cases around the world can be attributed to high Body Mass Index each year – including more than 7000 in Australia. (A new study by the International Agency for Research on Cancer found that nearly half a million new cancer cases per year can be attributed to high body mass index (BMI). The study was published on November 26 in The Lancet Oncology. Using its methodology, more than 7000 new cancer cases in Australia per year can be attributed to high BMI.)

The number of Victorians diagnosed with cancer is projected to double by 2024-2028 to more than 41,000 cases a year, with obesity considered a significant contributor to this. It’s a problem that we can’t ignore.

Many people are aware of the dangers of smoking, and the link between smoking and cancer – which is why we’ve seen such a rapid decline in smoking rates. At the same time we are seeing an equally rapid rise in the number of people who are overweight or obese. We need the same awareness about this as a risk factor if we are to stop more cancers before they start.

Drinking soft drinks contributes to higher kilojoule intake, weight gain and obesity. With one can of Coke containing 10 teaspoons of sugar, each can consumed increases the risk of being overweight.

The WHO recommends the consumption of sugary drinks should be restricted, as do Australia’s recently reviewed dietary guidelines, while the World Cancer Research Fund recommends consumption should be avoided entirely. Leaders in cancer control are meeting in Melbourne this week for the World Cancer Congress, and the challenges related to rising global obesity will be firmly on the agenda.

In the meantime, Coca-Cola continues to sugar-coat its image; fooling the community into believing it is part of the solution to the obesity epidemic.

Rather than being part of the solution like it claims, this multi-billion dollar company is trying to veil the impact of its products by positioning itself as a promoter of physical activity. This is merely a distraction from the fact that it continues to promote its sugary drinks as being part of a healthy diet.

Disturbingly, the company has aligned itself with organisations that encourage healthy active lifestyles, such as the Bicycle Network.

The decision by Bicycle Network to enter into a partnership with Coca-Cola attracted strong criticism from public health experts after a piece in Croakey a year ago, yet the partnership continues. This is especially problematic considering the ‘Happiness’ program is targeting teenagers, a group particularly susceptible to marketing and the highest consumers of these drinks.

Similarly, the Nutrition Society of Australia, the peak scientific nutrition group in the country, has Coca-Cola as a gold sponsor for its Annual Scientific Meeting underway in Tasmania.

This is disappointing on a number of levels, not least of all the fact that one of the themes for the conference is ‘Diet and cancer: what does the evidence show?’

Coca-Cola’s attempts to link itself with these organisations won’t reduce the consumption of sugary beverages and won’t make a gram of difference in reducing overweight and obesity.

Wouldn’t it be better to create alternative sponsorship sources for health-promoting organisations?

As was done with the banning of tobacco sponsorship and the creation of alternative funding sources through VicHealth, it’s time for some similarly creative thinking.

Creative thinking that will kick Coca-Cola out of sponsoring health-promoting activities, and create healthier options for organisations like the Nutrition Society and Bicycle Network.

My fear is that unless we take such action, we run the risk of limiting the impact of important health programs such as the Rethink Sugary Drinkcampaign, encouraging a switch to water and reduced-fat milk; and theLiveLighter campaign, which aims to help people make simple lifestyle choices to improve their overall health and cut their cancer risk.

These programs are vital yet are minnows in the campaign to win the healthy hearts and minds of the public when faced with the corporate might of the highly processed food and drink companies, but with some creative thinking and political will, the scales can be tipped in favour of a healthier way.

• Todd Harper is CEO of Cancer Council Victoria.

Jeffrey Braithwaite on Microlifes and Micromorts

Punchy.

http://www.jeffreybraithwaite.com/new-blog/2014/11/20/youll-be-dying-to-hear-about-this

You’ll be dying to hear about this

There’s lots of death in the world. Transport is risky, for instance—planes, automobiles, trains and ships can crash, maiming or killing passengers. You don’t have to go much further than seeing the road toll, or hearing about Malaysian Airlines Flight MH17 shot down over the Ukraine, or watching the TV scenes of the Costa Concordia, run aground just off Isola del Giglio near the coast of Italy, to appreciate that death is never far away.

Then there’s infectious diseases. You can all-too-readily catch a cold, or the flu, or TB, or lately, the Ebola virus. And there seem to be never-ending wars and skirmishes in the Middle East; and terror, spread by fundamentalists.

Each of these, depending on fate, can hasten someone’s demise. Wrong place, wrong time, wrong circumstances.

Lifestyle issues can cause problems for your risk profile too—but these are slower, and more stealthy. Think of smoking, drinking too much, eating yourself into a coma or just gross obesity, or the more insidious dangers of sitting at a computer for years on end with little exercise. These can translate over time into heart or lung disease, diabetes, and cancer.

Whether you are active or passive, things you do or don’t do can shorten your lifespan, or kill you a little or a lot faster than you would otherwise last. So what levels of risk do you actually, quantitatively, face in your own life?

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Stanford University decision scientist Ron Howard in the 1970s presented a novel way to calculate this risk. He introduced the idea of the micromort, defined as a one-in-a-million likelihood of death.  This is such an evocative unit of measurement that it deserves a little further attention.

If you live in the US or another relatively rich, OECD-style country, with good law and order, legislation that keeps society relatively risk free (such as with environmental and public health issues sorted out, effective building codes, and so forth), a well-educated population, access to health care, and a buoyant GDP, you can expect a micromort of one on any particular day. Another way of saying this is that’s the standard expected death rate for any individual today in any one 24 hour period: a microprobability of one in a million is your index of baseline risk.

These are great odds for you, today, as you read this; you are very likely to get through it. Congratulations if you do.

What circumstances lead to an elevated risk? Say if you do dangerous things or even just live life to the full? How does your micromort level get upgraded?

In the United States, you accumulate an extra 16 micromorts each time you ride a motorcycle 100 miles, for instance. Or 0.7 micromorts are added for each day you go skiing; so go for a week and you’ve added five more.

Or you might decide to do something a little more strenuous. With hangliding, the additional risk of dying equates to eight micromorts per flight; or skydiving, nine per freefall.

They are relatively benign compared to moving up to base-jumping. Do so, and you rapidly earn many more risk points: 430 micromorts per jump, in fact.

Marathon running, anyone? That will be seven micromorts to your debit account for each run. Even walking 17 miles adds one micromort, as does a 230 mile car trip, and add another one for every 6,000 mile train trip. But the puzzle is, it’s not always clear how to treat these: the walking introduces an element of risk (you could be out and about and get run over, or be struck by lightning) but it’s also beneficial (it contributes to improved health).

Perhaps even more interesting, there are microprobabilities associated with accumulated chronic risks in contrast to these other single-shot event risks. These are lifestyle choices and behaviors that incrementally add a little more risk through exposure. They won’t kill you if you have bad luck on a given day, but will slowly have an effect—and may claim you in the end.

Every half a liter of wine exposes you to a micromort because it can accrue into cirrhosis of the liver. Each one and a half cigarettes does the same, but the menace here is cancer or heart disease. Even eating 100 char-broiled steaks, 40 tablespoons of peanut butter or 1,000 bananas sneaks up on you in the form, respectively, of cancer risk from benzopyrene, liver cancer risk from aflatoxin B or cancer risk from radioactive potassium-40.

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Hang on though. I doubt I’ve done much to help anyone.

Because a clear problem is that people aren’t very good at doing these kinds of statistics, or applying them to their own lives—and are even less capable of acting on them. We can readily appreciate that skiing or motorcycling add some risk for the time you are doing them compared to the everyday activities of being at work or hanging out at home, yet many people are undeterred. People even cheerfully find ways of taking on more risk, such as by climbing Everest, driving fast cars, or having unsafe sex.

Everyone knows about that steadily accumulated risk, too: not too many of us are blind to the fact that drinking too much alcohol can lead to liver disease or smoking to lung cancer over time. And although both have been falling for decades, this hasn’t stopped millions of people indulging. There’s 42.1 million US smokers at last count, or 18.1% of the population, and on average each adult US citizen consumes 8.6 liters of alcohol annually.

This is not the best performance internationally but is by no means high by international standards, and Eastern Europeans smoke more heavily, and really give hard booze like vodka a nudge.  Nevertheless, both activities contribute to what public health people quaintly call excess deaths and the rest of us know by “their drinking or smoking (or both) killed them eventually.”

But what does it actually mean that you expose yourself to increased risk if you go out walking regularly or eat bananas?  We need another way of looking at this, because it’s too hard to do the sums.

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Enter the University of Cambridge medical statistician David Spiegelhalter and his colleague Alejandro Leiva who invented the idea of a microlife. This is another unit of risk which has the calculation built in for you. It is half an hour of your life.

If you increase your risk by one micromort, then this shortens your life by half an hour. These calculations apply to people on average, and work out for entire populations, but any one of us might be lucky or unlucky, depending on our individual characteristics. Any particular risk doesn’t convert exactly to the specific individual. But with enough people in the US (beyond 316 million now) and on the planet (7 billion and rising), there’s a relentlessness accuracy about the statistics.

So now let’s do some life expectancy math with Spiegelhalter. Smoke a pack a day? You lose up to five hours a day. Accumulated, that’s up to eight years off your life. Have six drinks a day and that binge costs you one half hour allocation—a shortened life by ten months or so. Stay eleven pounds overweight and you sacrifice half an hour every day you do so (another ten months across your lifespan), as you do if you watch TV for two hours. Your coffee habit at 2-3 cups daily takes away another half hour lot. So does every portion of red meat each day. Another ten months each time.

It’s not all negative. There’s good news. Eat five serves of fruit and vegetables every day and you gain up to a couple of hours each time. You get three years back. Exercise and the first 20 minutes per day earns you a surprising hour (there’s a good investment—a year and a half), and each subsequent 40 minutes adds up to one more half hour bonus to your credit (a bit more work but that seems a pretty good deal, too, to get a ten month return).

If you have a hobby, activity or diet and it’s not been dealt with so far, you can fill in some of the gaps with some good guesstimates. Do you have passive pursuits, akin to watching TV? This is a net deficit. Do you do active, exercise-oriented activities, such as weekly amateur netball, soccer, bowling or basketball—or just walking regularly? Add some lifespan.

These half hour allocations alter somewhat depending on your genetics of course (you can have lucky or unlucky genes) or your socioeconomic status (wealthy people typically live longer than poorer folks) or your gender (women on the whole live longer than men). That said, with this idea you are now able to alter your risk profile by changing your behavior with a tangible, calculable return.

*****

There’s a punchline to this, and it may be already occurring to you as you reflect on your own lifestyle and lifespan. There are a million microlives in fifty seven years of existence. That, for many of us, is roughly the adult allocation.

Let’s call that your life expectancy baseline. We can assume that you have had a reasonably healthy childhood (not so for everyone, of course, but true for many US children, and true for most readers). Then, from that point on, a large part of your healthy adult life is now measureable.

So: come out of your teens, reach your 21st birthday, and as the “jolly good fellow” and “happy birthday to you” songs subside, imagine you then have 57 years to go. That is, you have an allocation of 78 years in total, maybe a little longer, maybe a little shorter.

Yes, all sorts of unexpected things might happen along the way, but to some degree your lifespan is now no longer vague, but quantifiable. The actual life expectancy in the US indeed hovers around this: it’s 79.8 years overall, 77.4 for males and 82.2 for females. (It’s higher in some northern European countries and Japan, but that’s a story for another day).

However, you might be reading this thinking: Yikes. I’m not 21: I’m a bit older than that. In this case, you’ve already used up a proportion of your time left. Console yourself. At least you got through the riskiest stage of all: being a baby, up to one year of age, and childhood, up to six or so, when many things can go wrong.

But have you used what you were given so far, well? Or do you have a fair bit of regret?

To make an obvious point, however, this isn’t Doctor Who. You don’t have a Tardis to go back in time and fix the past. So stop any lamentations. Look forward.

By now, if you’ve come to value more readily each half hour and especially the cumulative effect of your lifestyle choices to date, don’t listen to me preaching. Feel completely empowered. You know what to do and how to alter your own numbers.

Now, all that’s left is to do the math. You’ll have a much clearer picture of your life and potential death than ever before. It’s your move: what’s next?

Further reading

Blastland, Michael and Spiegelhalter, David (2014). The Norm Chronicles: Stories and Numbers About Danger and Death. New York: Basic Books.

Howard, Ronald (1984). On fates comparable to death. Management Science 30 (4): 407–422.

Spiegelhalter, David (2012). Using speed of ageing and “microlives” to communicate the effects of lifetime habits and environment. British Medical Journal 345: e8223.

Spiegelhalter, David (2014). The power of the MicroMort. BJOG: An International Journal of Obstetrics & Gynaecology 121 (6): 662–663.

Population Health: A riddle wrapped in an enigma

PN: The health sector is very happy to take full responsibility for the health of the population for as long as substantial monies are tied to that claim. The moment the health sector is asked to account for it, they get nervous.

Tying funding to value is a terrifying prospect for the health sector as having to account for the benefit they deliver would inevitably lead to a diminution in income and status.

“Because so many factors lie outside clinicians’ control, we need to understand what factors the healthcare system can reasonably be expected to act on, given professionals’ training, infrastructure and scope of practice,” they said. “We also need to determine the appropriate levels of health system accountability for population health outcomes.

http://www.modernhealthcare.com/article/20150108/BLOG/301089997/population-health-improvement-still-a-riddle-wrapped-in-an-enigma

Population health improvement still a riddle wrapped in an enigma

The push to invest more of the healthcare industry’s time and money into promoting good health is, so far, uneven and uncertain in terms of effectiveness. Perhaps nowhere is that more apparent than in federal initiatives to broadly improve health by extending care beyond clinics and pharmacies into neighborhoods and homes.Federal funding for population-health efforts—the management of health and medical care for an entire group of patients or a community—has expanded under the Affordable Care Act. It’s included financing for states and providers to experiment with ways to better coordinate healthcare and other needs that affect health, such as housing and transportation. But the initiatives are not without risk or challenges, a point three federal officials underscored in the latest issue of the New England Journal of Medicine.

Efforts are still underway to identify what works and how to make widespread use of the most effective strategies, write Dr. William Kassler, Naomi Tomoyasu and Dr. Patrick Conway of the agency that oversees Medicare and Medicaid. The CMS Innovation Center, in a report to Congress last month, also said results were largely not yet available for nearly two dozen initiatives to bolster population health, improve quality and increase efficiency in healthcare, financed with $2.6 billion through last year.

Calculating a dividend from those investments presents another challenge, the trio wrote. Kassler is one of the CMS’ chief medical officers; Tomoyasu is deputy director of the prevention and population health care models group within the CMS Innovation Center; and Conway is the CMS’ deputy administrator for innovation and quality.

The return on any investment in prevention will necessarily take time, raising the risk that “current actuarial methods used to evaluate return on investment may underestimate potential savings,” they warned.

Investment at the federal level is not small. Medicare and Medicaid—which combined account for $1 of every $3 the nation spends on healthcare—have increasingly poured money into strategies for disease prevention and health promotion.

Those strategies extend the reach of healthcare beyond hospitals, clinics and pharmacies into neighborhoods, homes and schools. Such extended investment can include help with housing, transportation, literacy, day care and groceries, the officials wrote.

But with that expanded reach comes a debate “regarding the specific population-based activities that fall within healthcare providers’ scope of practice,” wrote the CMS officials. “Because so many factors lie outside clinicians’ control, we need to understand what factors the healthcare system can reasonably be expected to act on, given professionals’ training, infrastructure and scope of practice,” they said. “We also need to determine the appropriate levels of health system accountability for population health outcomes.”

Follow Melanie Evans on Twitter: @MHmevans

WSJ: Can a Smartphone Tell if You’re Depressed?

 

http://www.wsj.com/articles/can-a-smartphone-tell-if-youre-depressed-1420499238

Can a Smartphone Tell if You’re Depressed?

Apps, Other Tools Help Doctors, Insurers Measure Psychological Well-Being

HUNTERSVILLE, N.C.—Toward the end of Janisse Flowers’s pregnancy, a nurse at her gynecologist’s office asked her to download an iPhone app that would track how often she text messaged with friends, how long she talked on the phone and how far she traveled each day.

The app was part of an effort by Ms. Flowers’s health-care provider to test whether smartphone data could help detect symptoms of postpartum depression, an underdiagnosed condition affecting women after they give birth. The app’s developer, San Francisco-based…

The Temporary Tattoo That Tests Blood Sugar

 

http://www.theatlantic.com/health/archive/2015/01/the-temporary-tattoo-that-tests-blood-sugar/384581/

The Temporary Tattoo That Tests Blood Sugar

An electronic sensor may mean the end of finger pricking.

UC San Diego

A painful prick of the fingertip reveals a mountain of medical information for many diabetes patients. But health professionals have long struggled to find a reliable and painless way to gather blood sugar measurements. Just last year, Google announced that it was developing contact lenses that measure glucose levels in its user’s tears. But now, nanoengineers may have found an even easier way for diabetes patients to monitor their vital levels: temporary tattoos.

Amay Bandodkar, a researcher at the University of California, San Diego, has created a flexible sensor that uses a mild electrical current to measure glucose levels in a person’s body. Measuring blood sugar levels multiple times a day is vital for diabetes patients because it shows how well their body is managing their disease as well as the dose of insulin they require, if they need any at all. But because many people find needles unpleasant, they tend to avoid measuring their levels, which puts them at risk of developing serious medical complications. The new device is painless—It contains electrodes printed on a thin tattoo paper that patients can even dispose after use. “Presently the tattoo sensor can easily survive for a day,” Bandodkar said in a statement. “These are extremely inexpensive—a few cents—and hence can be replaced without much financial burden on the patient.”

The tattoo has already provided accurate glucose measures for seven healthy patients, the team reported in a recent issue of the journal Analytical Chemistry.The patients, all non-diabetics between the ages of 20 and 40, wore the tattoos before eating a sandwich and drinking a soda. Following the carb-rich meal, the tattoo recorded the spike in each patient’s glucose levels as accurately as a traditional finger-stick device. The tattoo is a few steps away from providing the numeric value of glucose levels, so scientists have to remove and analyze it in order to retrieve its measurements. Eventually, Bandodkar said the tattoo will have “Bluetooth capabilities to send this information directly to the patient’s doctor in real-time or store data in the cloud.”

The researchers hope the tattoo will eventually be used to monitor levels of other compounds in the blood, like metabolites, medications, or alcohol and illegal drugs. Whatever the application, the fewer needles the better.

A pinch of prevention will prevent a pound of turnstile medicine

 

http://www.afr.com/p/opinion/pinch_of_prevention_will_prevent_cTMfa5vns8VzT46UA8cigJ

JOHN DWYER

A pinch of prevention will prevent a pound of turnstile medicine

 

A pinch of prevention will prevent a pound of turnstile medicineA lack of infrastructure in Australia to care for more people in a community, rather than a hospital, costs us dearly. Photo: Louie Douvis

JOHN DWYER

Poorly considered and obviously unacceptable policies have forced the government to go back to the drawing board to consider ways to improve the cost effectiveness and sustainability of our health care system. This time let’s move beyond the government’s focus on having us pay more for a visit to our GP to concentrate on the evidence-based structural reforms we should be discussing. This time broad consultations are promised. Hopefully, the following facts and suggestions will influence decisions.

A good start would see the government stop talking about the fiscal sustainability of Medicare. Were it not for the destructive division of health care responsibilities shouldered by State and Federal governments, Canberra would not be looking at Medicare as if were isolated from the rest of the health care system. Hospital expenditure, at nearly $60 billion a year, dwarfs Medicare spending ($19 billion a year) and is increasing more rapidly. The immediate catalyst for changes to Medicare is not a fiscal crisis – our 9.3 per cent of GDP spent on health is about average for the OECD –but rather the unsatisfactory health outcomes delivered that are fuelling the growth in hospital care. A lack of any real infrastructure to provide our community with an improved capacity to prevent illness and care for more people in a community rather than hospital setting is costing us dearly.

More than 600,000 admissions to hospital each year (average cost more than $5000 per episode) could be avoided by a timely community intervention in the three weeks prior to admission. There is no doubt that the future of cost-effective, readily available hospital care is dependent on a reduction in the demand for hospital services. That must be the goal of a restructured Primary Care system. Last year Australians forked out $29 billion to supplement their health care (second only to the US in terms of out of pocket expenses). Much of this was spent on paying for surgery in the private sector. Public hospitals are swamped with complex medical patients seriously reducing their capacity to offer timely surgical services. Reducing medical admissions and restoring timely surgical services is a key to reigning in surgical costs and better educating the next generation of surgeons.

This time could our new health minister and her department open their eyes to international trends in cost effective health care that are producing better health outcomes. There is now an abundance of evidence that a focus on prevention in a personalised health system improves outcomes while slashing costs. Some systems have reduced hospital admissions by 42 per cent over the last decade. The British government has just been presented with a review that concluded that an extra 72 million ($132 million) spent on improving primary care in the community would save the system 1.9 billion ($3.5 billion) by 2020. The data available provides the government with a clear message that it does not want to hear. Only by spending more money on arestructuredMedicare will significant system wide savings be achievable.

A competent government would be looking at a timetable for introducing the highly successful Medical Home model of Primary Care, where teams of health professionals populate a practice and are available to enrolled patients. The infrastructure is available to help people avoid illness, have potential problems recognised earlier, offer co-ordinated in house care for people with chronic problems and care for many in the community currently sent to hospital. International experience tells us that a decade is required for the completion of necessary changes. We need to start on that journey and, fortunately, can do so without any panic about current health expenditure.

There is another related imperative that needs urgent action. Only 13 per cent of young doctors express any interest in becoming a GP. Only 1 per cent are contemplating a career as a rural GP. Primary Care training is rigorous and GPs are true specialists. How does all the rhetoric from Canberra about the pivotal role they play sit with the proposed $31 fee for a standard consultation. The discrepancy in the income potential for GPs when compared to that of other specialists is now huge.

Young doctors looking at the professional life of our GPs are uncomfortable with the current “fee for service” model that encourages turnstile medicine that is so professionally unfulfilling. Many GPs join corporate Primary Care providers preferring a salary. In New Zealand the government has facilitated 85 per cent of the nation’s GPs moving away from fee for service payments. The same is true for 65 per cent of US Primary Care physicians. Throughout the OECD health systems recognising the perverse incentives associated with fee for service remuneration are exploring changes that increase a GP’s remuneration for keeping people well.

There are numerous cost impositions in our health system that should be addressed before we are asked to pay more. Nine departments of health for 23 million people. A $5 billion dollar cost for the private health insurance rebate that could be better spent on achieving the above goals. $20 billion dollars spent on poor value or unnecessary procedures. The government asks: “if you don’t like our ideas then what would you do?” Well, here come the suggestions, please listen.

John Dwyer isEmeritus Professor of Medicine at the University of NSW.

The Australian Financial Review